神经刺激器定位腰骶丛阻滞在高危病人下肢手术中的应用

Lumbosacral plexus nerve block directed by peripheral stimulator in critical patients undergoing lower-extremity surgery

目的观察外周神经刺激器定位下的腰骶丛阻滞应用于高危病人下肢手术的效果。方法38例临床合并各种高危疾病拟行单侧下肢手术的病人,施行单侧腰骶丛神经阻滞。腰丛阻滞分腰肌间隙入路和腹股沟入路;坐骨神经阻滞为臀区入路。采用神经刺激器定位技术,刺激器电流频率1Hz,起始强度1mA,麻醉总量为1%利多卡因20ml,0.5%罗哌卡因30ml。结果38例病人均阻滞完善,麻醉效果满意,术中生命体征平稳,血流动力学稳定。结论神经刺激器定位技术下腰骶丛阻滞定位准确,客观指征明显,效果可靠,对患者各系统干扰小,对有严重合并症病人更为适用。

Objective To perform lumbosaeral plexus nerve block under peripheral stimulator in patients with high risk diseases undergoing lower-extremity surgery. Methods Thirty-eight patients undergoing lower-extremity surgery, ASA physical status of Ⅲ - Ⅳ, were subjected to one-side lumbosaeral plexus nerve block directed by a peripheral nerve stimulator. Depending on the different opertative site and passive poster, one or two of three approaches （psoas compartment approach, inguinal approach, transgluteal approach） were chosen to the branches of lumbar pluxus and to the sciatic nerve. The stimulation frequency was 1 Hz, and the stimulation currency was 1 mA. The total dose of local anesthetic was 30 ml 0. 5% ropivacaine and 20 ml 1% lidocaine. Results The block effects of 38 patients were satisfactory. Their hemodynamics was stable. Conclusion By means of a nerve stimulator, lumbosacral plexus nerve block is a good choice for lower-extremity anesthesia, especial to old critical patients.